# EDMOND AM CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Edmond AM Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760655773
- **Authorized official:** BILL J BUFFINGTON M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (405) 216-3993

## Contact information

- **Practice address:** 1714 S KELLY AVE, EDMOND, OK 73013-3624
- **Practice address phone:** (405) 216-3993
- **Practice address fax:** (405) 216-3992
- **Mailing address:** PO BOX 269083, OKLAHOMA CITY, OK 73126-9083
- **Mailing address phone:** (405) 216-3993
- **Mailing address fax:** (405) 216-3992

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | N/A | OK | Yes |

## Other

- **Enumeration date:** 04/10/2008
- **Last updated:** 10/21/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200134140A | — | OK |